Rinshō shinkeigaku = Clinical neurology
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A 68-year-old healthy woman without any evidence of recent wound, developed nuchal pain, difficulty in swallowing and trisumus in 10 days. Because of respiratory failure due to generalized muscle spasm, she was intubated and required mechanical ventilation. ⋯ Thereafter, her muscle spasm and hypertensive response were well controlled. The authors suggested that a combined use of midazolam and propofol was an optional antispastic therapy in patients with severe tetanus.
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Case Reports
[A case of methanol intoxication with optic neuropathy visualized on STIR sequence of MR images].
We report a 24-year-old man with severe methanol intoxication, who showed cerebral and optic nerve damages on MRI. He was admitted to our hospital with an acute onset of unconsciousness and severe metabolic acidosis, and was immediately treated by hemodialysis. His serum methanol concentration was 261.5 mg/dl. ⋯ Diffusion weighted images showed abnormal hyperintensities in bilateral putamina, subcortical white matter and cerebellar hemispheres. STIR sequence revealed bilateral optic nerve swelling with irregular hyperintense rims. These MRI features might reflect the optic nerve damages, mainly demyelination of the optic nerves caused by a myelinoclastic effect of formic acid, a metabolite of methanol.
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Case Reports
[Prolonged headache six weeks before ischemic symptoms due to vertebral artery dissection--a case report].
A 43-year-old woman presented with weakness in her left arm and leg. She had noticed headache persisting for 2 weeks in her right occipital area 6 weeks prior to the onset of the weakness. Cranial diffusion-weighted MR image demonstrated acute infarction in the right medial part of medulla oblongata. ⋯ Generally, in patients with cervicocephalic artery dissection with ischemic onset, the occurrence of headache is either simultaneous with the ischemic symptoms, or several days prior to the ischemic symptoms. The present case showed that headache due to arterial dissection can occur several weeks prior the ischemic symptoms. Precise history of headache should be taken in patients with cervicocephalic artery dissection.